IME

New York WCB Announces Amendments to IME Regulations

IME Practice Tips WCB Announcements

Section 137 of the New York Workers’ Compensation Law and 12 NYCRR §300.2 governs Independent Medical Examinations. As we previously discussed, it is imperative that you, the IME physician and your vendor meet the requirements of Section 137 or you run the risk of having your IME report precluded by the WC Law Judge.

The amendments affect not only physical examinations but also record reviews (peer review).

The significant changes are detailed on the WCB website [direct link].

The two biggest amendments pertain to the documenting of medical records reviewed by the examiner.

A new requirement has been added to the regulation that requires that every record, document, or test result supplied to an IME examiner for review in connection with an IME or records review must be a part of the Board file. Any information that is not already part of the Board file must be submitted before or at the time the IME or records review is arranged. Information submitted to the Board before or at the time the IME is arranged should not be submitted to the Board as a Request for Information using an IME-3.

This is important because often times the insurance carrier will obtain records (e.g. records received from treating provider in response to subpoena) and provide these along with the IME-3 to the IME for their review. The regulations now specifically note that this is not allowed and instead, the records the carrier wishes for the examiner to review, must be submitted to the Board file.

Additionally, “the submitting IME examiner must list all documents, reports, and other items reviewed in the IME or records review report.” This change is not as significant because the majority of IME reports already contain a comprehensive list of all medical records and diagnostic studies that the examiner reviewed at the time of their examination.

Make Sure To Meet The Requirements of Section 137 To Avoid Having IME Report Precluded

IME Practice Tips

Section 137 of the New York Workers’ Compensation Law and 12 NYCRR §300.2 governs Independent Medical Examinations. It is imperative that you, the IME physician and your vendor meet the requirements of Section 137 or you run the risk of having your IME report precluded by the WC Law Judge.

Nothing is more frustrating then receiving a favorable IME report and then finding out that a basic requirement in filing the report was not followed and therefore the report is likely to be precluded.

Section 137 has eleven specific requirements. The most common process flaws involve these two basic requirements:

1. A copy of each report of independent medical examination shall be submitted by the
practitioner on the same day and in the same manner to the board, the
insurance carrier, the claimant’s attending physician or other attending
practitioner, the claimant’s representative and the claimant

It is important that each of the above parties is sent the IME report, failing to send the report to one of the parties could result in the IME report being precluded.

2.  The claimant shall receive notice by mail of the scheduled independent medical examination at least seven business days prior to such examination. Such notice shall advise the claimant if the practitioner intends to record or video tape the examination, and shall advise the claimant of their right to video tape or otherwise record the examination. Claimants shall be advised of their right to be accompanied during the exam by an individual or individuals of their choosing.

If you don’t provide the appropriate notice, expect the report to be precluded.

Did you follow the correct procedures but the claimant failed to appear for a scheduled Independent Examination? Here are some recommendations.

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Claimant Failed To Appear For Scheduled IME, What’s The Next Step?

FAQs IME

If you are the employer/carrier it can be frustrating when you schedule the claimant for an Independent Medical Examination and they fail to appear for the scheduled examination. It can be even more frustrating if the carrier is under Board direction to continue awards.

The first thing you should do is verify that the notice of examination was sent to the claimant’s correct mailing address. Often, the reason why the claimant did not appear for the IME you or the vendor scheduled is because the notice informing them of the examination was sent to the wrong address.

If the notice was sent to the correct address, then you should file an RFA-2 requesting the Board schedule the case for a hearing. Indicate on the RFA-2 that awards and/or medical benefits to the claimant should be suspended due to their failure to appear for a scheduled IME.

Important note: If the carrier is currently paying the claimant awards under direction of the WCB, the carrier cannot suspend benefits without the approval of the Board.